Download
Download eBook for Free
Full Document
| Format | File Size | Notes |
|---|---|---|
| PDF file | 0.7 MB | Use Adobe Acrobat Reader version 10 or higher for the best experience. |
Summary Only
| Format | File Size | Notes |
|---|---|---|
| PDF file | 0.2 MB | Use Adobe Acrobat Reader version 10 or higher for the best experience. |
Purchase
Purchase Print Copy
| Format | List Price | Price | |
|---|---|---|---|
| Add to Cart | Paperback186 pages | $35.00 | $28.00 20% Web Discount |
The Medicare-Department of Defense (DoD) Subvention Demonstration tested Senior Prime as a managed care approach for enhancing access to affordable health care for Medicare-eligible DoD beneficiaries. While Senior Prime achieved solid beneficiary participation and satisfaction, it also raised a difficult set of challenges involved in applying managed care to the DoD health care system. These challenges included financial issues such as establishing equitable capitation rates and an appropriate level-of-effort baseline, as well as management issues such as effective care management and administrative processes for health plan sites. The basic structures of TRICARE and the DoD health system, including separate management jurisdictions and hierarchical budgeting methods, contribute to the challenges by creating incentives that discourage delivery of cost-effective care. Military treatment facilities need to be motivated not only to provide excellent care but also to manage appropriateness of care and related costs. Although DoD has decided to discontinue the Senior Prime model, many of the lessons learned from this demonstration are applicable to any managed care program that DoD may contemplate in the future.
Table of Contents
Section 1
Introduction
Section 2
Evaluation Methods and Data
Section 3
Senior Prime Implementation and Market Entry
Section 4
The Beneficiary's Perspective: Enrollment Demand and Perceptions of Senior Prime
Section 5
Early Effects of Senior Prime on Costs and Service Use
Section 6
Implications for Broader Use of an MTF-Based Option
Appendix A
RAND Process Evaluation Questions for Initial Site Visits
Appendix B
Template for Site Visit Agenda
Appendix C
RAND Process Evaluation Questions for Mid-Demonstration Review
Appendix D
FY96-FY98 RAND Data Documentation
The research described in this report was prepared for Centers for Medicare & Medicaid Services (CMS) and the DoD Tricare Management Activity (TMA) by RAND Health.
This report is part of the RAND Corporation Monograph report series. The monograph/report was a product of the RAND Corporation from 1993 to 2003. RAND monograph/reports presented major research findings that addressed the challenges facing the public and private sectors. They included executive summaries, technical documentation, and synthesis pieces.
This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited; linking directly to this product page is encouraged. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial purposes. For information on reprint and reuse permissions, please visit www.rand.org/pubs/permissions.
The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.